Category Archives: Diabetes

Diabetes – Information for Patients: Type 2 diabetes mellitus (Adult onset Diabetes) occurs when the pancreas is not able to produce a sufficient amounts of insulin, and/or the muscle or fat receptors becomes resistant to insulin. Either of these problems can result in high blood sugar (glucose) levels, which can lead to a numerous medical problems.
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Diabetes require regular monitoring (if you are healthy, usually every 3 months ) and continuous treatment to decrease your risks from Diabetes Militias. Treatment includes lifestyle changes, self-care measures, and medicines. The goal of treatment is to decrease the risks from diabetes which can include heart attacks. strokes, blindness, impotence, kidney disease and others.

TYPE 2 DIABETES – INFORMATION FOR PATIENTS – TREATMENT GOALS

Diabetes – information for patients: Blood sugar control —
The goal is to keep your sugar 110-130 fasting and 140-160, 2 hours after a meal, without complications. Sugar control can help prevent the long-term consequences of diabetes

Diabetes – information for patients Home blood sugar testing
Home blood sugar testing may be a good idea. This is especially true for those who take oral diabetes medicines or insulin, or whose sugar is not well controlled. Home testing is frequently NOT recommended for people whose Diabetes Militias is controlled with diet or who are very well controlled with medicaments.

Diabetes – information for patients A1C testing —
Average blood sugar , over 2-3 months, can be estimated with a test called glocosilated hemoglobin, or A1C. There are different recommendations for the A1C level, based on your health and response to control. Ideally, A1c should be kept as close to non diabetic levels as normal. This means that a level < 6.5 is desirable, so long as there are no problems in achieving this goal.

An A1c can be higher than the fasting blood sugar for several reasons:

Blood sugar goes up after eating.
Rapid or extreme amounts of eating can cause your blood sugar goes up at times other than when you are fasting.
If you are not active
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Controlling co-morbidities for Diabetes – information for patients

Quit smoking
Manage your high blood pressure and high cholesterol with diet, exercise, and medicines
Take a low-dose aspirin (81 mg) every day, if indicated

— Diet is aimed at achieving your ideal body weight (ibw); by doing so you can help decreasing your blood pressure, and improve your pancreas’ ability to control your sugar, augment your liver’s and muscles’ ability to respond to insulin.
Consistent exercise can help control type 2 diabetes. Exercise can help reduce weight, but even in the absence of weight loss, exercise can improve how the receptor sites on your muscle and fat responds to insulin. This can control your fasting sugar and A1c and thus reduce complications of DIABETES MILLITUS.

TYPE 2 DIABETES MEDICINES
— A number of oral medicines (pills) are available to treat type 2 diabetes.

Diabetes – information for patients: Metformin
— This is the most common medication you used in the treatment of DIABETES MILLITUS . Metformin (Glucophage, Glumetza, Riomet, Fortamet). improves how your body responds to insulin and decreases your inappropriate production of glucose from your liver – this helps to control DIABETES MILLITUS.

Metformin is often taken once with an evening meal. This medication can cause GI ( abdominal) side effects, after we are sure you don’t have these problems, a second dose may is often added, frequently at one to two weeks after initiation, with breakfast. The dose may be increased to a maximum of 1 gram 2 timers per day. Common side effects of Metformin include nausea, diarrhea, and gas. This medication can decrease your B12 levels. Patients with decreased kidney function, , liver disease , and some types of heart disease, those who can loose fluid (as with surgery) and those who drink alcohol excessively should may not be able to use Metformin. You should stop taking Metformin 48 hours before any test that uses iodine-based contrast dye, and you should stop it before you expect to loose a lot of fluid (extreme exercise, some surgeries, diarrhea etc.)

Diabetes – information for patients -other medications to consider

If your sugars are not adequately controlled (usually after 3 months) , Dr. Kline may suggest the use of a second (or even 3rd) medication.
The most commonly recommended second medicines are
Sulfonylureas
thiazolidinedione, such as pioglitazone
●A glucagon-like peptide (GLP)-agonist, such as exenatide
A newer type of medication such as Itrokona (canagoflozen)
A medication which can help delay absorption of food (such as Precose)
Insulin

I will discuss a few of these types of drugs below
Sulfonylureas

— Sulfonylureas increase the amount of insulin your body makes, and by doing this, can lower blood sugar levels. There are many problems with this class of medication, including the fact that they stop working after a time and that they decrease sugar in an uncontrolled manner (thus risking low blood sugar). Do not use a Sulfonylureas if you are allergic to “sulfa”. The Sulfonylureas include (Diabinese, Orinase, Glucotrol, DiaBeta, Micronase, Glynase, Amaryl), and the choice between them depends mainly upon cost, though they do work somewhat differently and certain medications are better than others for certain people.

hypoglycemia
The most common serious side effect with Sulfonylureas is low blood sugar, also known as hypoglycemia. Low blood sugar symptoms can include:

Sweating
Shaking
Feeling hungry
Feeling anxious

Low blood sugar should be rapidly corrected. This can be accomplished by eating 10 to 15 grams of fast-acting carbohydrate (e.g., fruit juice, hard candy, glucose tablets). If you do not treat this rapidly, you can pass out. Often people with bad hypoglycemia do not recognize that they have this problem, thus it is very important to have people around you who can diagnose this problem. It is important not to engage in hazardous activities if you can suffer from hypoglycemia.

Diabetes – information for patients Insulin
Insulin is now used early in diabetes to improve overall diabetes control and help to preserve the pancreas’s ability to make insulin. It is also used for people whose DIABETES MILLITUS is poorly controlled upon initial diagnosis.

Insulin injections may be used as a the primary treatment in Diabetes Militias. It can also can be added to or substituted for oral medicines. Insulin must be injected under the skin. As a rough generality, there are 2 major types of Insulin – basil insulin and fast acting. Normally basal insulin’s are used at bedtime – the idea is that they work all day long at a constant level. On the other hand fast acting medications are use before meals and work for a short to find time only. Fast acting insulin can cause hypoglycemia, for this reason, it is very important for people who use insulin to check their sugars as Dr. Kline recommends.

Thiazolidinediones (tzd’s) – is

This class of medicines includes pioglitazone (Actos). Tzd’s work by increasing the body’s sensitivity to insulin, this allows a smaller amount of insulin to have a greater effect. Tzd’s are pills, and are usually “add on” drugs which means that they are usually taken in combination with other medicines such as Metformin, a Sulfonylureas, or insulin. Side effects of Thiazolidinediones include:

Weight gain and swelling of the feet and ankles.
A small risk of developing or worsening heart failure in people who already have “bad hearts”. For this reason, if you take Thiazolidinediones please monitor for swelling of your feet.
A small risk of developing serious fluid retention at the back of the eyes (macular edema), a certain types of bladder cancer (very rare),and bone fractures (rare). These medications may also HELP cardiac function and are good to use if hypoglycemia is an issue.

GLP-agonistic —

The GLP-agonistic, exenatide (Byetta) and liraglutide (Victoza). Like insulin, you must inject these medicines. These medications are expensive and are used if your blood sugar is not controlled with oral medications. or if oral medications produce too many side effects to be effective by themselves. GLP’s can help you to loose weight, and are often used by overweight patients. GLP-agonists do not usually cause low blood sugar. Side-effects include nausea, vomiting, and diarrhea. Pancreatitis has been reported rarely in patients taking GLP-agonists, but a causal relationship has not been definitively established. You should stop taking GLP’s if you develop abdominal pain. Exenatide should not be used in patients with abnormal kidney function.

DPP-IV Inhibitors

— This class of medicines includes sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and vildagliptin (Galvus). These medications are expensive, but their costs are decreasing. DPP IV’s work by increasing insulin release from the pancreas in response to a meal and by decreasing sugar production at the same time. They are not usually a first-line treatment, but they can be given alone in patients who can’t tolerate the first-line medicines (Metformin, Sulfonylureas). They are frequently used with other oral medicines when control is near, but not at goal. These medicines do not cause hypoglycemia or changes in body weight. Side effects include nausea and diarrhea, and (like the GP’s) there have been reports of Pancreatitis and skin reactions.
Meglitinides —

Meglitinides include repaglinide (Prandin) and nateglinide (Starlix). They work to lower blood sugar levels, similar to the Sulfonylureas, but can often be used on those allergic to sulfa. They are pill but are more expensive than Sulfonylureas. Since they are short-acting, they must be taken with each meal.

Alpha-glucosidase inhibitors

— AGI’s include acarbose (Precose) and miglitol (Glyset). These medications work by delaying the absorption of carbohydrates in the intestines, and in this way allow the decreased amount of insulin in DIABETES MILLITUS to have more time to work. This helps to lower blood sugar levels. AGI’s can be combined with other medicines, and they do NOT produce hypoglycemia. Side effect’s include gas (flatulence), diarrhea, and abdominal pain. Managing these side effect can be frequently be accomplished by starting at a low dose. AGI’s are usually taken with the first bite of each meal. Agi’s are non-powerful medications.

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